Health at Senate’s gate

President Obama’s frontline, election-winning manifesto, promising universal healthcare to all Americans, just cleared the first crucial hurdle in being passed by House of Representatives. It is now knocking the doors of the Senate for a final approval before it becomes an epoch making law – a dream and a serious attempt of so many former presidents who tried and failed, leaving such legislation to the realm of those noble thoughts that become the staple of many a discussion, even ending up, generating a philosophy of the unsurpassable limitations of the human mind and the systems it is capable of creating.

It was not without the predictable slander, criticism, resistance, even to the extent of calling it an open misleading damned lie, cheap enough to take the underprivileged for a ride, that both Obama and his monumental promise had to survive to reach the present status. The Republicans, even now are busy refilling their pens, their laptops loaded with precedents and statistics, waiting for the document to be delivered on their desks, to announce why they always were, and even now are, wary of the discrepancies in what they call is a patchwork, populist wording, that may only sound perfect on paper, but practically makes no difference at the ground level, between what the transactions are today, and what they will be, if the Bill is passed.

Surely, such path-breaking laws have enough in substance as well as in rhetoric that invites a serious counterassault, not all of it being the bias of those who thought, tried, and finally gave up. Some of this is evident in the manner in which the bill was negotiated throgh the House. The present phrasing is a significantly watered down version of the document at the point of entry. Two major setbacks are that cost restrictions are on account of excluding insurance cover for ‘abortions’, and clauses that give further latitude to the caregiver to curtail Medicare expenses. Both these deviations may actually be construed as infringing on the sensitive issue of constitutional rights of women and the elderly, the two key population subsets, the law and the constitution closely monitors in its guardianship.

A story that is making incessant rounds is that quite a few of the statements recorded by Democrats as well as Republicans actually had ghostwriters provided by the genetic Pharma major, ‘Genentech’, an arm of the Switzerland-based Roche. There are similarities in the wordings of many of them, and those asked have expressed surprise at the coincidence, but no one has taken offence to this or even vehemently denied it. Interestingly, a different form of marketing is working here. The applicability of the bill is being linked to further research and job creation, which is good for the economy, and will prevent outsourcing to generic majors in India. This indeed is very intelligent political manoeuvering, temporarily shifting to a possible (but unsure) premise that the Republicans will find difficult to counter. The determination and steering of the document so far shows extremely deft handling.

An ardent, committed and more experienced co-campaigner for President Obama is the highly influential former President Clinton. Earlier in his first term, Clinton noticed the 15% health-uncovered segment of the population. He enunciated reforms that would allow the formation of Health Insurance Financial Cooperatives, where by groups under an employer, or self-formed conglomerates could shop and bargain for an insurance cover, on the strengths of their numbers. It was a fine initiative, but failed to become a law, bringing in the predictable embarrassment and distancing from health reforms during his second term. A retro-analysis showed that it failed on two of the three basic components of HealthCare. These include the insurance (who is insured and who pays), the coverage (the plan, what diseases are covered and to what extent), and health delivery (the setup, interventions and professionalism in the provider). The Clinton plan targeted the costs primarily. Those benefits were, however, lost in the other two inseparable components of a comprehensive healthcare system. In many ways President Obama will be depending heavily on Clinton’s influence over the Senate, and his lessons form the past. Clinton, currently is doing just that, as a co-parent of this baby, and maybe still has an eye on the elusive Nobel peace prize.

When the Senate finally takes up the discussion, the obvious questions to crop up, are the republican suggestions to cut costs on medical litigation (paradoxically, lawyers earn four times as physicians, because they compensate for the wrongs, rather can curing), and the very important subject of coverage for illegal immigrants. Though the way around the first will have to be chiseled out carefully, a free market, low cost, insurance setups may be set aside to tackle the needs of the illegal migrants. On the sly, many such ‘moonlighting’ clinics are in existence, run by resident immigrant doctors, under the Clinton pretext of, "Don’t ask, Don’t answer".

The healthcare horse has always been too big for his stable, and continues to grow. Finally, my best guess is that with these two great stalwarts behind it, they might just push him in, with one synchronized effort, and put on the latch, even though most of his neck may continue to hang out. That would be a threshold change – the smashing of a psychological barrier, like Bannister’s beating of the four-minute mile, or man’s landing on the moon. It may be like a long chess game, ending with the winner having just two extra pawns.

The horse may not be too happy, but for once it is closeted, it will adjust. The next target is already on the scene. Expand the stable, and keep it well fed.

Sometimes the first challenge is to make a horse drink. He may start frequenting the water on his own.

DISCLAIMER : Views expressed above are the author's own.

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Author

Anoop Kohli is a senior consultant neurologist at the Indraprastha Apollo Hospital, New Delhi. His interests go far beyond his chosen profession. For him, it's just one game of life so interesting to study for all its themes and aberrations. He also dabbles in script-writing and recently got a membership of the Bombay Film Writers' Association. In this blog, Masquerader, expect from him anything from H1N1 to Heena.